Manage Risks to Protect the Liver While Using Methotrexate

Appropriate monitoring can prevent chronic liver disease associated with methotrexate therapy. Key risk factors for liver toxicity include elevated BMI, which increases the likelihood of fatty liver and subsequent hepatic fibrosis; insulin-dependent diabetes, which raises the risk of non-alcoholic steatohepatitis (NASH); and significant alcohol consumption, which exacerbates liver effects. To minimize methotrexate side effects, supplementation with folic acid (1-2 mg daily) can help alleviate common issues like mouth sores, headaches, diarrhea, nausea, and fatigue. If side effects persist despite folic acid, consider using felineic acid or leucovorin, starting at 5 mg taken 8 to 12 hours after methotrexate administration.